“Them that can eat have no meat and them that have meat cannot eat!” said Henry VIII who suffered from gout. Gout was then considered a disease of aristocrats, as they were the only people who could afford red meat and alcohol. Excessive consumption of the two was for centuries considered to be precipitating factors for the disease. Today, we know that it is due to high uric acid levels in the blood (more than 7 mg /dl). The incidence of gout is increasing, with the highest rates of change being in India, China and Thailand. Gout now affects 0.3 per cent of the Indian population.

Uric acid is a product of purine metabolism found in all living cells with high concentrations in protein rich foods such as red meat, fish, yeast, broccoli, cabbage, cauliflower and some beans. Beer too has a high purine content while other liquors elevate uric acid levels in the blood as they are metabolised.

The levels of uric acid can increase despite a normal diet if there is increased cell destruction in the body as in leukaemia and sickle cell disease. The levels may also go up as a side effect of certain medications.

Typical gout starts abruptly — in the middle of the night when the temperature dips. Sharp shooting pains appear in the big toe, ankle or knee. The joint becomes red and swollen. There may be fever. This may initially lead to a mistaken diagnosis of inflammatory arthritis.

With or without treatment, the pain may subside 48-72 hours later, and then disappear forever in a lucky few. In others, it re-appears after months or years. Eventually, if left untreated, it may progress to chronic gout, with swollen and deformed joints. Crystallised uric acid may be deposited under the skin as visible “gouty tophi” on the ear, fingers and toes. These appear as movable lumps which eventually grow larger, become painful and interfere with joint movement. The kidney tries to excrete the excess uric acid, which may precipitate there to form stones. It can eventually lead to kidney failure.

Uric acid levels may increase if the body has a problem with eliminating normal quantities of uric acid. This occurs in the obese, the diabetic and those with abnormal lipid levels. Genetically predisposed males develop gout in the forties. Women are protected till menopause, after which their uric acid levels can go up.

Not everyone with high uric acid levels exhibits symptoms. Some people remain asymptomatic all through life.

The diagnosis of gout is confirmed by blood tests to estimate blood uric acid levels, aspiration of fluid from the joints to demonstrate crystals, X-rays or a synovial biopsy.

During an acute attack of gout, the pain can be relieved with medication. Some non steroidal anti-inflammatory agents work better in some people than others. Indomethecin and Nalidixic are particularly effective. Injections of steroids into the affected joints may also be needed. Later, once the acute attack has subsided, drugs like allopurinol may have to be taken regularly to lower blood uric acid levels.

Although medication is the mainstay of gout treatment, for faster pain relief soak the affected joint in hot water with rock salt in it. Then apply ice.

Lifestyle modifications can help to reduce the severity and frequency of attacks.

• Maintain ideal body weight. Although a BMI (body mass index) of 23 is ideal, gout is precipitated when BMI goes above 35.

• Reduce alcohol intake. Beer and binge drinking increase the likelihood of attacks.

• Increase your consumption of carbohydrates. Reduce red meat. If you are vegetarian, remember that some vegetables too contain a lot of purine.

• Coffee reduces blood uric acid levels.

• Vitamin C reduces uric acid. Eating more than 500mg a day as tablets can cause side effects. It is better to get your requirements by squeezing half a lime into every glass of water.

• Eat 2-3 bananas a day.

• Drink 4 litres of water a day. This will help wash out the uric acid and prevent it forming stones in the kidney.

• Exercise for an hour a day. It will correct obesity, metabolic derangements in sugar and lipid levels and help to maintain ideal body weight.

The chance of developing diseases is radically reduced by maintaining ideal body weight and exercising daily. Just putting one foot in front of the other and walking on the road for 40 minutes a day will increase your longevity and keep you healthy.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in